AHRQ Grants for Health Services Research Dissertation Program (R36), Chiarello, February 1, 2010) Elizabeth Chiarello Dissertation Research: Pharmacists of Conscience: Ethical Decision-Making and Consistency of Care Project Summary, Pharmacists are increasingly important to quality patient care. As pharmacists engage in clinical work in retail and hospital settings, they face new ethical challenges. Recent contention over a few pharmacists refusing to dispense certain reproductive health medications has prompted state legislatures to pass laws about moral refusals. These laws call into question the grounds of pharmacists'decision-making - whether discretion is limited to legal grounds or expanded to moral grounds. Most research on pharmacist responsibility laws focuses on the philosophical question of whether a pharmacist should be able to opt out or the empirical question of how refusals affect patient access. This study contributes to these bodies of research by focusing on the pharmacist, a linchpin connecting drug availability and patient access. Specifically, this study examines institutional and individual influences on pharmacists'discretion. By focusing on discretion in general, this research will help illuminate how pharmacists make ethical decisions in complex institutional environments;this investigation is important to the future direction of health care in which pharmacists will play an increasingly important role. This study has four specific aims: 1) Assess the extent to which law, political environment, work setting, and personal beliefs influence pharmacists'ethical decision-making;2) examine how pharmacists understand the bounds of their discretion;3) evaluate the consequences of constraining pharmacists'discretion to legal grounds versus expanding it to moral grounds;4) explain how pharmacist responsibility laws influence other aspects of practice. To achieve these aims, the primary investigator will conduct interviews and surveys with pharmacists in eight counties in four states with different pharmacist responsibility laws: California, Kansas, Mississippi, and New Jersey. A maximum variation sample of pharmacists in each county will provide a broad perspective on ethical decision-making. Past research in four states demonstrates the feasibility of the study. Findings will contribute to the dialogue about pharmacist responsibility laws by accounting for institutional and individual factors other than law that could influence dispensation. This will help broaden the set of recommendations for increasing access to care while preserving pharmacists'crucial role in protecting patient safety.) PUBLIC HEALTH RELEVANCE: AHRQ Grants for Health Services Research Dissertation Program (R36), Chiarello, February 1, 2010) Elizabeth Chiarello Dissertation Research: Pharmacists of Conscience: Ethical Decision-Making and Consistency of Care Project. This project examines how pharmacists make challenging ethical decisions in their work. By interviewing pharmacists who work in settings with different laws, organizational policies, and political communities, this research considers how these dimensions influence decision-making. Since pharmacists'decisions help determine who can access specific drugs, understanding how they make choices is important for ensuring patient safety and access to care.)